Japanese Encephalitis finds a new target: adults

Traditionally regarded as a disease of children, it is spreading among 25 to 40-year-olds

The increasing number of Japanese Encephalitis (JE) cases among adults has become a cause of concern for health experts in the country. The cases are being reported from Uttar Pradesh, Bihar, Assam and some other states in the north-east.

JE has traditionally been regarded as a disease of the children and before mid-2009, the proportion of adults among JE patients rarely exceeded 2 per cent.

Assam first reported a big jump last year — as many as 70 per cent of patients were above 15 years old. In UP too, the number of adult patients has been increasing since last year, although it has not yet reached the proportions it has acquired in Assam.

While counting JE cases, anyone above 15 is considered an adult, but the new patients, at least in UP, are mostly between 25 and 40 years old.

An official in the Union Ministry of Health said in view of this new trend, the Centre is examining the possibility of introducing JE vaccination for adults in selected high-risk areas. Three years ago, Nepal had undertaken JE vaccination f adults. Since children had already been vaccinated, and JE vaccination is given once in life, there was no need to continue with it.

The official said Centre will also take steps to identify the reasons behind the virus affecting more and more adults.

But without waiting for the Centre's decision, the Assam government has decided to undertake vaccination of adults in its high-risk areas in the first quarter of 2011.

Unlike Assam, however, the UP government does not want to start vaccination of the adult population, hoping that the problem would not rise to the magnitude of Assam.

"The age shift in UP is not so sharp as in Assam, so there is no plan to start vaccination of adults as of now," said Dr VS Nigam, Joint Director, Vector Born and Communicable Disease wing of the Uttar Pradesh Health Department.

Regarding the situation in UP, Dr KP Kushwaha, Head of Pediatrics Department at Gorakhpur's BRD Medical College, said: "It is true that in our record, we have noticed this trend that the number of JE as well as Acute Encephalitis Syndrome cases among adults is increasing since last year. About 700 AES cases have been reported among adults this year — of these around 100 were JE."

Last year, the number of JE patients among adults was only 30, the number of AES patients was not immediately available.

Gorakhpur is located in the area worst hit by JE in eastern UP. So, the patients are invariably taken to the BRD Medical College. Since JE is, so far, regarded as a disease of the children, Kushwaha's department handles them. Whenever a patient arrives, it is registered as a case of AES, which could be caused by various viruses which are similar to JE. After tests, JE patients are listed separately.

Kushwaha said some parts of the increase could be "because the total number of AES cases has increased from about 2,100 last year to about 3,000 cases this year".

But there is another disturbing trend: while the mortality rate of the disease among children has been around 13.7 per cent, the mortality rate among adults was close to 16 per cent this year, he said.

Health Department officials said the trend has been noticed mainly in Gorakhpur and Kushinagar districts. The other JE affected district in eastern UP are Deoria, Siddharthnagar, Basti, Maharajganj, Sant Kabir Nagar, Balrampur, Mau and Azamgarh.

IndianExpress